6 research outputs found

    Oral lichen planus and hepatitis C virus infection; a symbiotic relationship or a mere co-incidence?

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    Background: Lichen planus (LP) is a common idiopathic chronic inflammatory immune mediated mucocutanous disease that effects stratified squamous epithelia and appendices. Hepatitis C virus (HCV) infection is quite common across the world. A couple of reports have suggested positive association of HCV infection and oral lichen planus (OLP) and most of the studies are usually confined to Mediterranean and south European countries. Due to high incidence and suspected alliance between these two diseases in Pakistan, the following study was conducted with the view that it may help clinicians to set guidelines for HCV testing of lichen planus patients.Methods: Approximately 11500 patients from general population coming to dental diagnostics department of Fatima Memorial Hospital, Lahore (from March 2015-February 2016) were screened clinically for OLP and by ELISA for HCV infection. Out of these 11500 patients 103 were selected one of them incidental and the other pre-diagnosed or both incidental and both pre-diagnosed. These patients were unaware but had either one or both OLP and HCV infection which was confirmed clinically and by ELISA respectively.Results: Majority of patients presenting for other dental complaints were unaware of these diseases process going on in them and was mostly an incidental finding by the clinician. Either one or both OLP and HCV infection were more conjoint in females comprising 77.7% of the total subjects. OLP alone was most common finding comprising 66.67% of the cases. HCV infection alone was present in 15.53% whereas 16.50% subjects showed presence of both OLP and HCV infection.Conclusions: The current study could not detect statistically significant relationship between OLP and HCV infection in Pakistani population which could be due to genetic variation or may be geographic relationship

    Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

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    Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

    Oral lichen planus and hepatitis C virus infection; a symbiotic relationship or a mere co-incidence?

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    Background: Lichen planus (LP) is a common idiopathic chronic inflammatory immune mediated mucocutanous disease that effects stratified squamous epithelia and appendices. Hepatitis C virus (HCV) infection is quite common across the world. A couple of reports have suggested positive association of HCV infection and oral lichen planus (OLP) and most of the studies are usually confined to Mediterranean and south European countries. Due to high incidence and suspected alliance between these two diseases in Pakistan, the following study was conducted with the view that it may help clinicians to set guidelines for HCV testing of lichen planus patients.Methods: Approximately 11500 patients from general population coming to dental diagnostics department of Fatima Memorial Hospital, Lahore (from March 2015-February 2016) were screened clinically for OLP and by ELISA for HCV infection. Out of these 11500 patients 103 were selected one of them incidental and the other pre-diagnosed or both incidental and both pre-diagnosed. These patients were unaware but had either one or both OLP and HCV infection which was confirmed clinically and by ELISA respectively.Results: Majority of patients presenting for other dental complaints were unaware of these diseases process going on in them and was mostly an incidental finding by the clinician. Either one or both OLP and HCV infection were more conjoint in females comprising 77.7% of the total subjects. OLP alone was most common finding comprising 66.67% of the cases. HCV infection alone was present in 15.53% whereas 16.50% subjects showed presence of both OLP and HCV infection.Conclusions: The current study could not detect statistically significant relationship between OLP and HCV infection in Pakistani population which could be due to genetic variation or may be geographic relationship

    Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

    No full text
    BackgroundTranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding.MethodsWe did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.FindingsBetween July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98).InterpretationWe found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial.</div
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